Cardiac Arrest in Pregnancy

In this lesson, we're going to cover treatment options for both the mother and the baby when the mother experiences a cardiac arrest event. At the end of this lesson, we'll explain why the new recommendations were made.

There are several special considerations that you will need to make for a pregnant patient in cardiac arrest. First, the treatment priorities for the mother should focus on the following options:

1. High-quality CPR
2. Oxygenation
3. Fibrillation
4. ACLS medications

In addition to the above priorities to the mother's care, there also needs to be one healthcare provider whose only responsibility is to care for the newborn.

The Importance of Oxygenation and Airway Management

Because a pregnant patient is more likely to have hypoxia, it's vitally important to place a high priority on oxygenation and proper airway management during resuscitation. Also because of potential interference with maternal resuscitation, fetal monitoring should NOT be attempted during cardiac arrest.

To help relieve compression of the mother's abdominal aorta and inferior vena cava, left lateral uterine displacement should be done with one or two hands by pushing or pulling the abdomen to the mother's left side.

You should also consider that the initial efforts from maternal resuscitation may not be successful, and you should begin to prepare for perimortem cesarean delivery. These efforts should begin immediately.

Care for the Newborn Immediately After Birth

After the baby is born, inflation and ventilation of the lungs will be your top priority. If the infant is born with meconium-stained amniotic fluid, routine endotracheal suctioning for both vigorous and non-vigorous infants is NOT recommended.

ET suctioning should only be done if the airway obstruction is suspected after providing positive pressure ventilation. A rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions.

If the newborn requires vascular access immediately following birth, the umbilical vein is the recommended route. If IV access is not feasible, it may be reasonable to use the IO route instead.

Consider the Reversible Causes of Cardiac Arrest: The Hs & Ts

With any pregnant patient, it is especially important to consider and treat the reversible causes of cardiac arrest in order to provide the best possible chances of survival.

In addition to the Hs and Ts, other common causes of maternal cardiac arrest are:

• Hemorrhage
• Heart failure
• Amniotic fluid embolism
• Sepsis
• Aspiration pneumonitis
• Venous thromboembolism
• Preeclampsia and eclampsia
• Complications of anesthesia

Team Planning is Vital for Good Outcomes

To achieve the best possible outcomes for the mother and newborn, healthcare providers need to conduct team planning with the following:

• Obstetrics
• Neonatal
• Anesthesiology
• Intensive care
• Emergency
• Cardiac arrest services

A Word About Why These New Recommendations Were Made

The recommendations for managing cardiac arrest in pregnancy were reviewed in the 2015 Guidelines Update and a 2015 AHA scientific statement. Airway, ventilation, and oxygenation are particularly important in the setting of pregnancy because of an increase in maternal metabolism, a decrease in functional reserve capacity due to the gravid uterus, and the risk of fetal brain injury from hypoxemia.

Evaluation of the fetal heart is not helpful during maternal cardiac arrest, and it may distract from necessary resuscitation elements. In the absence of data to the contrary, pregnant women who survive cardiac arrest should receive targeted temperature management just as any other cardiac arrest survivors would, with consideration for the status of the fetus that may remain in utero.